Tuesday, March 25, 2008

Buffing and Turfing

I can’t believe that I am fixing people. When I say that I don’t mean it in a I-am-so-honored-to-have-the-ability-to-heal-people way, but rather in a What-the-hell-am-I-doing-that-actually-makes-people-less-sick? sort of way.

Why? Because I feel I do nothing that directly helps people get through their times of acute illness. All I do during my day is order lab work, consult other services, and then follow up on those tests and consults. Then, seemingly miraculously, I get to discharge patients home because somehow their symptoms -- or, more importantly, their lab values -- have improved. I don’t know precisely when in the above process patients actually improve. They come to the hospital sick, I order countless tests, the patient and I both wait for the results, and then I discharge them home.

All this makes me wonder: is this medicine? If so, it is kind of shocking ... especially since I have already seen the inner workings of a hospital before, as a medical student. I cannot help but think of House of God, that classic novel of life inside a hospital during the internship of six new interns. Early on the main character describes this very sentiment, saying:

“This internship is nothing like what I thought it would be. What do we do for these patients anyway? They either die or we BUFF and TURF them to some other part of the [hospital]”

His resident then responds with “That’s modern medicine”.

(Turfing is slang for the act of transferring patients to another service, and buffing is the term for fixing up a patient enough so that they can’t return back to your service once you turf them).

Great. Again, maybe this really is modern medicine -- just doing whatever it takes to get patients off of your service. That book, by the way, was written in 1978.

I feel this is the point where the surgeons get to laugh and say, “I told you so”. They always mock internists for doing too much thinking (and rounding) and not enough doing. It is the heart of the rivalry between medicine and surgery, and it’s based in truth. We, as their medicine counterparts, don’t get to solve medical problems directly by fixing them with our hands, but achieve it indirectly via ordering drugs. The immediate satisfaction surgeons feel after a successful procedure is hard to achieve when a patient’s improvement comes as a result of administering a drug.

In any case, the future -- at least the next three years of it -- is looking a little more bleak and a little less satisfying now that I realize I’ll be doing this for 80 hours a week for the duration of my training. Perhaps it will change for the better once I become a resident. Or, perhaps, I’m destined to a life of buffing and turfing.

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